14D0880664 CLIA NUMBER - FCH RURAL HEALTH CLINIC VANDALIA

Laboratory Demographics

CLIA Number: 14D0880664

Facility Name: FCH RURAL HEALTH CLINIC VANDALIA

Facility Address:
1442 NORTH 8TH STREET SUITE C
VANDALIA, IL
ZIP 62471
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Facility Phone Number: 618 283-0266

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1568500510

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0880664
LAB Type	Physician Office
Facility Name	FCH RURAL HEALTH CLINIC VANDALIA
Street	1442 NORTH 8TH STREET SUITE C
City	VANDALIA
State	IL
ZIP	62471
Phone	618 283-0266
CertificateType	4
CertificateEffectiveDate	12/17/2023
CertificateExpirationDate	12/16/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024